Evaluation of blood loss during internal (limb-salvage) hemipelvectomy for pelvic tumours : what have we learned so far?

• Main Authors: Sharifudin, Mohd Ariff, Wan Ismail, Wan Faisham Numan, Wan, Zulmi, Mat Zin, Nor Azman, Mohamed Amir, Nawaz Hussain, Mohamed Amin, Mohamed Azril, Goh, Kian Liang
• Format: Conference or Workshop Item
• Language: English; English; English; English
• Published: 2013
• Subjects: RB Pathology; RC0254 Neoplasms. Tumors. Oncology (including Cancer); RD701 Orthopedics
• Online Access: http://irep.iium.edu.my/30356/6/06_-_ICMHS_2013_-_Compilation_of_Abstracts_%28please_refer_to_page_105%29.pdf; http://irep.iium.edu.my/30356/1/01_-_ICMHS_2013_%28SLIDE_PRESENTATION%29_-_Bleeding_in_Pelvic_Surgery.pdf; http://irep.iium.edu.my/30356/2/02_-_ICMHS_2013_-_Letter_of_Acceptance.pdf; http://irep.iium.edu.my/30356/5/05_-_ICMHS_2013__-_Conference_Book_%28pg_61%29.pdf; http://irep.iium.edu.my/30356/

Introduction: Pelvic tumour resections are complex and associated with extensive bleeding. Despite various blood management options in orthopaedic surgery, their used are limited particularly for pelvic tumour resections. Identifying predictive factors for a large amount of blood loss during surgery is essential. Objective: To evaluate the volume of blood loss in limb salvage pelvic resections and identify the risk factors for large amount of perioperative blood loss. Methodology: We retrospectively reviewed 25 patients underwent pelvic tumour resections performed between 2000 and 2010 in a single institution. Tumours originating from the sacrum were excluded. Total blood volume loss consisted of estimated intra-operative blood loss and the drainage volume on the first day after surgery. Loss of more than 3000ml of blood was classified as large amount of blood loss. Statistical analysis performed using Fisher’s exact test. Results: Six (24.0%) patients had total blood loss greater than 3000ml. Resections of primary bone sarcomas (osteosarcoma and chondrosarcoma) have the highest mean blood loss volume (6556.67ml and 1768.57ml, respectively). Most important factor associated with large amount of blood loss is the involvement of the acetabulum. Neo-adjuvant therapies and pre-operative embolization were not shown to be associated with extensive blood loss.. Conclusion: Resections of pelvic tumours involving the acetabular region are likely to have a large amount of blood loss perioperatively and should be anticipated. Radiation therapy prior to surgery was believed to increase the risk of bleeding intra-operatively, was not observed in this study.